"I am very happy I started offering the free care. My patients' faces picked up and my spirits picked up," says Arvind Goyal MD, MPH, a solo family physician in Rolling Meadows, Ill.

No job, no bill: Physicians tell how they help longtime patients struggling during recession

Experts say for the cost of a few visits, physicians can build up long-term loyalty that will pay off when hard times end.

By Karen Caffarini — Posted March 16, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The six-physician ob-gyn practice of K. Anthony Shibley, MD, noticed an unusual scheduling pattern. Whenever a corporate layoff was announced, a surge of patients suddenly wanted to move up appointments or schedule them before their insurance ran out.

The suburban Minneapolis practice decided it wanted to assure patients that it wouldn't abandon them in their time of need. So it is letting all 10,000 of them know that if they are laid off and lose their insurance, they can get one free preventive visit and one Pap smear per year until they get another job and insurance.

Experts say such a move is a way to engender patient loyalty, because when the economy gets better, those patients will remember how you treated them when times were tough. Also, experts say the money lost in offering free preventive care to the unemployed is likely to be far less than the costs these patients might run up -- and be unable to pay -- if they wait to see you only if they are very sick.

Whatever you do, you want to communicate this sentiment to your patients: "We're all in this together."

That's the word from Arvind Goyal, MD, MPH, a solo family physician in Rolling Meadows, Ill. Since the 1980s, he has offered free visits to his established patients from the time they lose one job until they land another. Dr. Goyal said he lost some income, but the rewards offset any loss.

"When you practice medicine, sometimes the reward of doing a good job is money, sometimes it is just the internal satisfaction," Dr. Goyal said. "With these patients, you get back more in terms of loyalty. I've had some patients come and lobby with me in Springfield [at the Illinois state Capitol] on malpractice issues."

Dr. Shibley said his group is offering the free care to current unemployed patients because it tells patients the practice is a big believer in prevention, both to keep patients healthy and to keep health costs down.

"We wanted to put meaning behind our words and really be partners in their preventive care during this economic crisis," Dr. Shibley said. "The patients appreciate this and will keep coming here once they get back into their groove."

Setting parameters

Experts and physicians who offer free care advise that you inform all your patients of the program. It's one way to build up goodwill for the practice. Dr. Shibley's practice, for example, sent e-mails to patients and keeps fliers about the program in the office.

Aside from getting the word out, discretion is key. Patients receiving free care should be integrated into your schedule just as any other patient. Discretion doesn't end in the exam room. Marks made next to the free patients' names alert Dr. Shibley's front desk staff to not ask for money or an insurance card.

But experts say physicians also need to set clear limits. Any free-care policy should spell out who is eligible, the nature of the care available for free and what is the patient's responsibility to pay. Dr. Shibley's practice requires that patients bring in proof of lost insurance.

"Physicians need to understand they cannot get overwhelmed with free patients to the point it prevents access to other patients and hurts them financially," said Frederick Wenzel, PhD, professor of medical practice management at the University of St. Thomas in Minneapolis. "A couple patients aren't that big a deal, but if there is a nearby plant closing and word gets around of your offer, you might need to ration care."

That hasn't been necessary for Dr. Shibley. He said only a handful of patients have used the benefit so far. Dr. Goyal said he saw about five people for free in the last six months.

"Some take me up on my offer. Some are too proud," Dr. Goyal said. "I just know I have not become poor because of the offer."

Neither Dr. Shibley nor Dr. Goyal have any intention of capping the number of patients who will be seen for free.

Other alternatives

Experts say there are other ways physicians can help unemployed patients, such as payment plans and assistance in getting them get state aid or Medicaid. In Florida, uninsured patients can negotiate rates for treatment, similar to how insurers operate.

Dr. Goyal also tries to ease unemployed patients' financial pain by giving them sample medication or switching them to generics. He refers those who need medical care beyond what he can provide to one of the nearby free clinics or a hospital that does charity work.

Albert Puerini, MD, and about 40 other family physicians in their 170-doctor practice near Providence, R.I., have taken a different path. They provide care for some patients when a local free clinic is overflowing.

Dr. Puerini said the clinic had been asking area doctors to help relieve them of the growing crowd of patients, who were being seen on a lottery system. He said he wanted to help but couldn't get away from the office for the several hours it would take to go to the clinic in South Providence. Now he sees about five free clinic patients with chronic conditions a month at his office.

"They become my patient. They are part of my roster, and they are scheduled and treated the same as any other patient," Dr. Puerini said.

Dr. Shibley said his practice is committed to providing the free visit and exam through 2009. He and his partners will assess the program at the end of the year to determine if it will be continued.

Back to top


How to handle patient spikes when layoffs hit

With every announcement of job losses, physicians brace for a rush of patients who want to get medical care before they lose their insurance. "Everyone knows of someone using that time to get a procedure done or annual visit in," said Louise Baumgardner, spokeswoman for Pinnacle Health System in Harrisburg, Pa.

Consultants say there are several ways doctors can accommodate a large number of urgent scheduling requests:

  • Leave open slots in the schedule. That way you can accommodate those with more urgent needs, said Jennifer Zarate, president and CEO of the Professional Medical Staff Assn., health care consultants in Olathe, Kan. But don't create so many scheduling holes that you can't fill them, advised Bill Bristow, partner with DoctorsManagement, practice management consultants in Knoxville, Tenn.
  • Move wellness care appointments to a later date, provided medications don't need to be updated, Bristow suggested.
  • Offer limited evening or weekend hours after a mass layoff. While this would require paying overtime or bringing in temporary help, Bristow said, it makes financial sense in most instances.
  • Delegate work that staff can do, such as getting sample medications, and focus on just those tasks that require a doctor, Bristow said.
  • Approach a local company that is having a mass layoff to see if it would sponsor a health clinic as part of a severance package for employees who are about to be laid off. Zarate said these clinics would be similar to sports physical and flu clinics and would allow all employees to be seen at one time.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn